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December 1998

Multivariate Analysis of 9 Disease-Associated Variables for Outcome Prediction in Patients With Sepsis

Author Affiliations

From the Division of Surgical Sciences, Department of Surgery, University of Medicine and Dentistry of New Jersey[[ndash]]Robert Wood Johnson Medical School, New Brunswick (Drs Calvano and Lowry and Ms Coyle), and Department of Surgery, Cornell University Medical College, New York, NY (Ms Barbosa and Dr Barie).

Arch Surg. 1998;133(12):1347-1350. doi:10.1001/archsurg.133.12.1347

Objective  To assess the ability of 9 clinical or biological variables to predict outcome (survival or nonsurvival) using multiple regression and classification analyses.

Design  Prospective, descriptive cohort study with no interventions.

Setting  Surgical intensive care unit of a tertiary care hospital and a medical school research laboratory.

Patients  Eighteen patients with a documented source of infection who met currently accepted criteria for sepsis syndrome or septic shock.

Main Outcome Measures  Prediction of survival or nonsurvival based on analysis of clinical (Multiple Organ Dysfunction score, Acute Physiology and Chronic Health Evaluation III scores) and biological (plasma levels of cortisol, interleukin 6, interleukin 10, phospholipase A2, soluble tumor necrosis factor receptor p75, and monocyte membrane tumor necrosis factor receptor levels) variables, with comparison of predicted and actual outcomes.

Results  Plasma interleukin 6, interleukin 10, and phospholipase A2 concentrations were not significantly (P>.05) different between survivors and nonsurvivors. By standard, forward stepwise, and backward stepwise multiple regression analyses, only monocyte membrane tumor necrosis factor receptor levels measured at the onset of sepsis significantly predicted outcome in all 3 analyses. However, by both standard and backward stepwise analyses, Multiple Organ Dysfunction scores based on evaluation at the onset of sepsis and 24 hours later were also significant predictors of outcome. Classification analysis showed that assignment to outcome group was statistically significant when based on monocyte membrane tumor necrosis factor receptor levels determined at the onset of sepsis or on Multiple Organ Dysfunction scores assessed 24 hours after sepsis was diagnosed.

Conclusion  Although these findings were based on a relatively small cohort, both multiple regression and classification analyses indicated that only monocyte membrane tumor necrosis factor receptor levels are able to discriminate survivors from nonsurvivors at the onset of sepsis.